How Much Waste Is There in the Health Care System?

Think that it's a small problem? Think again

Hungarian doctor Ignaz Semmelweis suggested 165 years ago that simply by washing their hands, physicians would reduce the high death rate among women during childbirth. He couldn't prove it, though, and since he predated Louis Pasteur, antiseptics and antibiotics, Semmelweis' advice was ignored. He was hounded out of his profession and died in disgrace.
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Much has changed. Still, health professionals have not learned to wash their hands. That's the thrust of an important new study by the Institute of Medicine. It documents the historic medical, technological and demographic changes driving the health care industry. Yet up to half of health professionals fail to wash their hands before beginning medical procedures. "The U.S. health care system now is characterized by more to do, more to know, and more to manage than at any time in history," the study said. "The result is a paradox: advances in science and technology have improved the ability of the health care system to treat diseases, yet the sheer volume of new discoveries stresses the capabilities of the system to effectively generate and manage knowledge and apply it to regular care."

These dynamics have balkanized the system, even as the demands on it multiply, especially from a population living longer with more chronic disease. "If home building were like health care, carpenters, electricians, and plumbers each would work with different blueprints, with very little coordination," the study found.

The staggering cost of this dysfunction has now been quantified. Americans spend $2.8 trillion a year on the health care system, according to the Centers for Medicare & Medicaid Services. That includes the cost of unneeded and excessive treatment, of mistakes and errors, unnecessary bureaucracy, missed prevention opportunities and the cost of fraud. Altogether, the institute concluded, the American health care system wastes $765 billion a year. That exceeds the annual defense budget and by all accounts is preventable.

That's where we as patients come in. We see the inefficiencies firsthand. "Patients often find the health care system uncoordinated, opaque and stressful to navigate," the study found. For example, Medicare patients now see an average of seven physicians, sometimes resulting in conflicting prescriptions and almost always requiring new paperwork for doctors and insurers at every stop.

The report demands serious attention. It's also an opportunity to develop a patient's checklist — a small step that can have real impact. When meeting with doctors, take notes so you understand clearly the available options. Include a friend in the consultation. List the medications you already take. Talk to the person directing your care. Encourage your doctors to utilize digital record-keeping. Ask questions. And make sure they've washed their hands.